Michigan Office of Administrative Hearings and Rules

Administrative Rules Division (ARD)

611 W. Ottawa Street

Lansing, MI 48909

Phone: 517-335-8658 Fax: 517-335-9512

REGULATORY IMPACT STATEMENT

and COST-BENEFT ANALYSIS (RIS)

Agency Information:

Department name:

Licensing and Regulatory Affairs

Bureau name:

Bureau of Professional Licensing

Name of person filling out RIS:

Dena Marks

Phone number of person filling out RIS:

517-335-3679

E-mail of person filling out RIS:

MarksD1@michigan.gov

Rule Set Information:

ARD assigned rule set number:

2021-74 LR

Title of proposed rule set:

Public Health Code – General Rules

Comparison of Rule(s) to Federal/State/Association Standard

1. Compare the proposed rules to parallel federal rules or standards set by a state or national licensing agency or

accreditation association, if any exist.

Each state establishes its own requirements with respect to license and registration renewals and other requirements

for licensure or registration. Consequently, there are no federal rules or standards set by a national or state agency to

which the proposed rules can be compared.

A. Are these rules required by state law or federal mandate?

MCL 333.16194 requires that the department prescribe the expiration dates for licenses and registrations for health

care professions.

MCL 333.16174 requires the department to establish the minimum standards for determining if an applicant for

licensure or registration has a working knowledge of the English language.

The rules are not required by federal mandate.

B. If these rules exceed a federal standard, please identify the federal standard or citation, describe why it is

necessary that the proposed rules exceed the federal standard or law, and specify the costs and benefits arising out

of the deviation.

The proposed rules do not exceed a federal standard.

2. Compare the proposed rules to standards in similarly situated states, based on geographic location, topography,

natural resources, commonalities, or economic similarities.

The proposed rules are consistent with the standards required by the Public Health Code and are largely consistent

with the requirements of other states in the Great Lakes region. Every state in the Great Lakes region provides for the

length of a license or registration cycle and license or registration renewal dates.

MCL 24.245(3)

RIS-Page 2

A. If the rules exceed standards in those states, please explain why and specify the costs and benefits arising out of

the deviation.

Most states in the Great Lakes region do not require implicit bias training for relicensure or reregistration. Illinois has

a law requiring implicit bias training for obstetricians.

The cost of completing implicit bias training in Michigan will vary, depending on the program that an individual

chooses to attend. For example, Mary Free Bed Hospital in Grand Rapids, as well as several other hospitals in

Michigan, offer implicit bias training courses free of charge. Additionally, this rule is required pursuant to Executive

Directive 2020-07.

Research indicates that there is an economic burden associated with health care inequities. As such, reducing barriers

to health care access and disparities in the delivery of health care will yield social and economic benefits long term.

The time investment required to obtain implicit bias training (1 hour per year for relicensure and reregistration

applicants) is relatively small when compared to the potential benefits that will be realized by Michigan residents.

3. Identify any laws, rules, and other legal requirements that may duplicate, overlap, or conflict with the proposed

rules.

There are no other laws, rules, or other legal requirements that may duplicate, overlap, or conflict with these proposed

rules.

A. Explain how the rules have been coordinated, to the extent practicable, with other federal, state, and local laws

applicable to the same activity or subject matter. This section should include a discussion of the efforts undertaken

by the agency to avoid or minimize duplication.

No coordination is needed because there are no other applicable laws that regulate the areas addressed in the proposed

rules.

4. If MCL 24.232(8) applies and the proposed rules are more stringent than the applicable federally mandated

standard, provide a statement of specific facts that establish the clear and convincing need to adopt the more

stringent rules.

MCL 24.323(8) does not apply.

5. If MCL 24.232(9) applies and the proposed rules are more stringent than the applicable federal standard,

provide either the Michigan statute that specifically authorizes the more stringent rules OR a statement of the

specific facts that establish the clear and convincing need to adopt the more stringent rules.

MCL 24.232(9) does not apply.

Purpose and Objectives of the Rule(s)

6. Identify the behavior and frequency of behavior that the proposed rules are designed to alter.

MCL 24.245(3)

RIS-Page 3

The intended purpose of the proposed rules is set forth below:

R 338.7001a: This rule provides for biennial license and registration renewal. Amendments will be made to clarify

when a license or registration must be renewed, and the renewal date for occupational therapy, physical therapy, and

respiratory therapy will be changed to the date of the year when the licensee’s initial license was issued. The rule is

designed to advise a licensee of the renewal date for a biennial license or registration.

R 338.7002: This rule provides for triennial license and registration renewal. Amendments will be made to clarify

when a license or registration must be renewed, and the renewal date for counseling and social work will be changed

to the date of the year when the licensee’s initial license was issued. The rule is designed to advise a licensee of the

renewal date for a triennial license or registration.

R 338.7002b: This rule provides the minimum English language standard for licensure or registration. Amendments

will be made to clarify that the International English Language Testing System (IELTS) Academic test and the Test of

English as a Foreign Language Internet-Based Test (TOEFL-IBT) to demonstrate a working knowledge of the English

language must be taken within 2 years of the date of application for licensure or registration because test scores

cannot be verified after 2 years. This amendment is designed to ensure that an applicant for licensure or registration

understands when the test must be taken and how to comply with the standard.

R 338.7003: This rule provides the notice of the Stark Law required by MCL 333.16221, and the department’s

adoption of the Stark Law and federal regulations under the Stark Law. Amendments will be made to provide up-to-

date information concerning revisions to both the Stark Law and the federal regulations under the Stark Law.

R 338.7004: This rule provides the requirements for implicit bias training. Amendments will be made to clarify that

an applicant for relicensure or reregistration has the same requirements under the rule as an applicant for license or

registration renewal. The proposed changes will ensure that Michigan residents do not encounter barriers or

disparities in the access to or in the delivery of health care services.

A. Estimate the change in the frequency of the targeted behavior expected from the proposed rules.

The proposed rules are intended to ensure that current renewal cycles are identified, up-to-date information regarding

the Stark Law is provided, to increase awareness of health care inequities among applicants for relicensure and

reregistrant applicants, and to decrease the frequency of the targeted behavior.

B. Describe the difference between current behavior/practice and desired behavior/practice.

R 338.7001a: This rule provides for biennial license and registration renewal. The proposed amendments are

intended to update the information to inform a licensee or registrant when a biennial license or registration must be

renewed.

R 338.7002: This rule provides for triennial license and registration renewal. The proposed amendments are intended

update the information to inform a licensee or registrant when a triennial license or registration must be renewed.

R 338.7002b: This rule provides the minimum English language standard for licensure or registration. The proposed

amendment is intended to ensure that the applicant understands when the testing must be completed to satisfy the

minimum English language requirement for licensure or registration.

R 338.7003: This rule provides the notice of the Stark Law required by MCL 333.16221, and the department’s

adoption of the Stark Law and federal regulations under the Stark Law. Amendments will be made to provide up-to-

date information concerning revisions to both the Stark Law and the federal regulations under the Stark Law.

R 338.7004: This rule provides the requirements for implicit bias training. Amendments will be made to clarify that

an applicant for relicensure or reregistration has the same requirements under the rule as an applicant for license or

registration renewal. The proposed changes will ensure that Michigan residents do not encounter barriers or

disparities in the access to or in the delivery of health care services.

C. What is the desired outcome?

MCL 24.245(3)

RIS-Page 4

R 338.7001a: This rule provides for biennial license and registration renewal. The desired outcome is timely renewal

of a biennial license or registration.

R 338.7002: This rule provides for triennial license and registration renewal. The desired outcome is timely renewal

of a triennial license or registration.

R 338.7002b: This rule provides the minimum English language standard for licensure or registration. The desired

outcome is compliance by the applicant.

R 338.7003: This rule provides the notice of the Stark Law required by MCL 333.16221, and the department’s

adoption of the Stark Law and federal regulations under the Stark Law. The desired outcome is to provide up-to-date

information concerning revisions to both the Stark Law and the federal regulations under the Stark Law.

R 338.7004: This rule provides the requirements for implicit bias training. Amendments will be made to clarify that an

applicant for relicensure or reregistration has the same requirements under the rule as an applicant for license or

registration renewal. The desired outcome is applicant compliance, increased awareness, and greater equity in access

to and the provision of health care services.

7. Identify the harm resulting from the behavior that the proposed rules are designed to alter and the likelihood

that the harm will occur in the absence of the rule.

R 338.7001a: This rule provides for biennial license and registration renewal. The proposed rules are designed to

inform a licensee or registrant regarding the license or registration renewal date and to assist the licensee or registrant

in complying with renewal requirements.

R 338.7002: This rule provides for triennial license and registration renewal. The proposed rules are designed to

inform a licensee or registrant regarding the license or registration renewal date and to assist the licensee or registrant

in complying with renewal requirements.

R 338.7002b: This rule provides the minimum English language standards for licensure or registration. The proposed

rule is designed to assist the applicant in complying with licensure or registration requirements.

R 338.7003: This rule provides the notice of the Stark Law required by MCL 333.16221, and the department’s

adoption of the Stark Law and federal regulations under the Stark Law. The proposed rule is designed to provide up-

to-date information concerning revisions to both the Stark Law and the federal regulations under the Stark Law.

R 338.7004: This rule provides the requirements for implicit bias training. Amendments will be made to clarify that

an applicant for relicensure or reregistration has the same requirements under the rule as an applicant for license or

registration renewal. The rule is intended to promote equity in access to and the provision of health care services in

Michigan.

A. What is the rationale for changing the rules instead of leaving them as currently written?

MCL 24.245(3)

RIS-Page 5

R 338.7001a: The rationale for changing this rule is to provide clarification for renewal of a biennial license or

registration and advise that the renewal date for occupational therapy, physical therapy, and massage therapy will be

the date of the year when the licensee’s initial license was issued.

R 338.7002: The rationale for changing this rule is to provide clarification for renewal of a triennial license or

registration and advise that the renewal date for counseling and social work will be changed to the date of the year

when the licensee’s initial license was issued.

R 338.7002b: The rationale for changing this rule is to clarify for an applicant for licensure or registration how long

test results earned on the International English Language Testing System (IELTS) Academic test and the Test of

English as a Foreign Language Internet-Based Test (TOEFL-IBT) can be verified to satisfy the requirement that the

applicant demonstrate a working knowledge of the English language.

R 338.7003: The rationale for changing this rule is to provide up-to-date information concerning revisions to both the

Stark Law and federal regulations under the Stark law.

R 338.7004: The rationale for changing this rule is to ensure that an applicant for relicensure or reregistration has the

same training requirements as an applicant for renewal. This rule will ensure that the relicensure or reregistration

applicant is educated regarding implicit bias and its effect on their behavior. This will improve equity in the delivery

of health care to Michigan residents.

8. Describe how the proposed rules protect the health, safety, and welfare of Michigan citizens while promoting a

regulatory environment in Michigan that is the least burdensome alternative for those required to comply.

R 338.7001a: This rule provides for biennial license and registration renewal. The proposed rule will protect the

health, safety, and welfare of Michigan residents by ensuring that a licensee or registrant renews the license or

registration on time.

R 338.7002: This rule provides for triennial license and registration renewal. The proposed rule will protect the

health, safety, and welfare of Michigan residents by ensuring that a licensee or registrant renews the license or

registration on time.

R 338.7002b: This rule provides the minimum English language standard required for licensure or registration. The

proposed rule will protect the health, safety, and welfare of Michigan residents by ensuring that a licensee or registrant

can communicate effectively with a patient or client.

R 338.7003: This rule provides the notice of the Stark Law required by MCL 333.16221, and the department’s

adoption of the Stark Law and federal regulations under the Stark Law. The proposed rule is designed to provide up-

to-date information concerning revisions to both the Stark Law and the federal regulations under the Stark Law and

will continue to protect Michigan citizens from inappropriate referrals by physicians.

R 338.7004: This rule requires an applicant for licensure, registration, renewal, relicensure, or reregistration to

complete implicit bias training. The proposed rules will protect the health, safety, and welfare of Michigan residents

by ensuring equitable access to and provision of health care services.

9. Describe any rules in the affected rule set that are obsolete or unnecessary and can be rescinded.

No rules can be rescinded.

Fiscal Impact on the Agency

Fiscal impact is an increase or decrease in expenditures from the current level of expenditures, i.e. hiring additional staff,

higher contract costs, programming costs, changes in reimbursements rates, etc. over and above what is currently

expended for that function. It does not include more intangible costs for benefits, such as opportunity costs, the value of

time saved or lost, etc., unless those issues result in a measurable impact on expenditures.

MCL 24.245(3)

RIS-Page 6

10. Please provide the fiscal impact on the agency (an estimate of the cost of rule imposition or potential savings

for the agency promulgating the rule).

The proposed rules are not expected to have a fiscal impact on the agency.

11. Describe whether or not an agency appropriation has been made or a funding source provided for any

expenditures associated with the proposed rules.

No agency appropriation has been made or a funding source provided because there are no expenditures associated

with the proposed rules.

12. Describe how the proposed rules are necessary and suitable to accomplish their purpose, in relationship to the

burden(s) the rules place on individuals. Burdens may include fiscal or administrative burdens, or duplicative

acts.

R 338.7001a: This rule provides for biennial license and registration renewal. The proposed rule does not place a

burden on an individual.

R 338.7002: This rule provides for triennial license and registration renewal. The proposed rule does not place a

burden on an individual.

R 338.7002b: This rule provides the minimum English language standards required for licensure or registration. The

proposed amendment to the rule does not place a burden on the individual. The proposed rule clarifies for an

applicant who has taken the International English Language Testing System (IELTS) Academic test or the Test of

English as a Foreign Language Internet-Based Test (TOEFL-IBT) how long the test results can be verified so that the

applicant can satisfy the working knowledge of the English language requirement for licensure or registration. It

does not place any new burden on an individual.

R 338.7003: This rule provides the notice of the Stark Law required by MCL 333.16221, and the department’s

adoption of the Stark Law and federal regulations under the Stark Law. The proposed rule is designed to provide up-

to-date information concerning revisions to both the Stark Law and the federal regulations under the Stark Law. The

proposed rule does not place any new burden on an individual.

R 338.7004: This rule provides that an applicant for relicensure or reregistration must have completed implicit bias

training. The cost of obtaining this training will vary, depending on the program the individual chooses. Several

Michigan hospitals offer implicit bias training free of charge. This rule will impose a burden on health care

professionals by requiring that they invest time in obtaining implicit bias training; however, promoting equity in

access to and the provision of health care services to the residents of Michigan greatly outweighs that burden.

A. Despite the identified burden(s), identify how the requirements in the rules are still needed and reasonable

compared to the burdens.

The cost to take implicit bias training will vary, depending on the program chosen. Several Michigan hospitals offer

free implicit bias training. Health care professionals will need to invest their time to obtain implicit bias training, but

the investment of time is outweighed by the overall benefit of ensuring greater equity in access to and the provision

of health care services.

Impact on Other State or Local Governmental Units

13. Estimate any increase or decrease in revenues to other state or local governmental units (i.e. cities, counties,

school districts) as a result of the rule. Estimate the cost increases or reductions for other state or local

governmental units (i.e. cities, counties, school districts) as a result of the rule. Include the cost of equipment,

supplies, labor, and increased administrative costs in both the initial imposition of the rule and any ongoing

monitoring.

There are no anticipated increases or reductions for other state or local governmental units as result of the proposed

rules.

14. Discuss any program, service, duty, or responsibility imposed upon any city, county, town, village, or school

district by the rules.

There are no anticipated or intended programs, services, duties, or responsibilities imposed on any city, town, village,

or school district as a result of these proposed rules.

MCL 24.245(3)

RIS-Page 7

A. Describe any actions that governmental units must take to be in compliance with the rules. This section should

include items such as record keeping and reporting requirements or changing operational practices.

There are no anticipated actions that a governmental unit must take to comply with the proposed rules.

15. Describe whether or not an appropriation to state or local governmental units has been made or a funding

source provided for any additional expenditures associated with the proposed rules.

No appropriations have been made to any governmental units as result of the proposed rules. No additional

expenditures are anticipated or intended with the proposed rules.

Rural Impact

16. In general, what impact will the rules have on rural areas?

The proposed rules impose requirements on individual licensees or registrants, so rural areas are not impacted by the

rules. Even if a licensee’s or registrant’s workplace is located in a rural area, the department could not exempt the

licensee or registrant from these requirements because it would create a disparity in the regulation of the profession.

A. Describe the types of public or private interests in rural areas that will be affected by the rules.

The proposed rules will not impact public or private interests in rural areas.

Environmental Impact

17. Do the proposed rules have any impact on the environment? If yes, please explain.

The proposed rules will not have any impact on the environment.

Small Business Impact Statement

18. Describe whether and how the agency considered exempting small businesses from the proposed rules.

The proposed rules impose requirements on individual licensees and registrants rather than small businesses. Even if

a licensee’s or registrant’s workplace qualifies as a small business, the department could not exempt the business

because it would create a disparity in the regulation of the profession.

19. If small businesses are not exempt, describe (a) the manner in which the agency reduced the economic impact

of the proposed rules on small businesses, including a detailed recitation of the efforts of the agency to comply

with the mandate to reduce the disproportionate impact of the rules upon small businesses as described below (in

accordance with MCL 24.240(1)(a-d)), or (b) the reasons such a reduction was not lawful or feasible.

The rules cannot exempt small businesses because the rules do not directly regulate small businesses. The rules

regulate individual licensees and registrants. Further, the Public Health Code requires the included professions to be

licensed or registered, even if the licensee or registrant works in a small business.

While a licensee or registrant may work independently or as part of a small business, the law does not allow the rules

to exempt these individuals from the requirements of these rules. However, the impact on a licensee or registrant who

works as part of a small business is minimized in the proposed rules, as the rules are written broadly. The proposed

rule changes will have minimal or no impact on a licensee or registrant. As a result, a licensee or registrant, whether

in small business or not, should not be significantly impacted by the changes.

A. Identify and estimate the number of small businesses affected by the proposed rules and the probable effect on

small businesses.

It is estimated that small businesses will not be affected by the proposed rules. The proposed rules affect individuals

only.

B. Describe how the agency established differing compliance or reporting requirements or timetables for small

businesses under the rules after projecting the required reporting, record-keeping, and other administrative costs.

The agency did not establish separate compliance or reporting requirements for small businesses. The proposed rules

will apply to all licensees and registrants. The rules were drafted to be the least burdensome on all affected licensees

and registrants.

C. Describe how the agency consolidated or simplified the compliance and reporting requirements for small

businesses and identify the skills necessary to comply with the reporting requirements.

MCL 24.245(3)

RIS-Page 8

The agency did not consolidate or simplify compliance and reporting requirements for small businesses with the

proposed rules because the proposed rules do not impact small businesses.

D. Describe how the agency established performance standards to replace design or operation standards required

by the proposed rules.

The agency did not establish performance standards to replace design or operation standards required by these rules.

20. Identify any disproportionate impact the proposed rules may have on small businesses because of their size or

geographic location.

The proposed rules do not impact small business. They impact an individual registrant or licensee. Therefore, there

is no disproportionate impact on a small business because of its size or geographic location.

21. Identify the nature of any report and the estimated cost of its preparation by small businesses required to

comply with the proposed rules.

The proposed rules affect individuals applying for licensure and renewal, regardless if they practice in a small

business. There is no separate cost to a small business.

22. Analyze the costs of compliance for all small businesses affected by the proposed rules, including costs of

equipment, supplies, labor, and increased administrative costs.

There are no expected costs for equipment, supplies, labor, or administrative costs that a small business would incur

in complying with the proposed rules.

The rules impact licensees and registrants and not small businesses.

23. Identify the nature and estimated cost of any legal, consulting, or accounting services that small businesses

would incur in complying with the proposed rules.

There are no expected costs for legal, consulting, or accounting services that a small business would incur in

complying with the proposed rules.

24. Estimate the ability of small businesses to absorb the costs without suffering economic harm and without

adversely affecting competition in the marketplace.

There are no expected costs to a small business that will cause economic harm to a small business or the marketplace

as a result of the proposed rules.

25. Estimate the cost, if any, to the agency of administering or enforcing a rule that exempts or sets lesser

standards for compliance by small businesses.

The proposed rules impose requirements on individual licensees and registrants rather than a small business. Even if

a licensee’s or registrant’s practice qualifies as a small business, the department could not exempt the business

because it would create disparity in the regulation of the profession.

Therefore, there is no cost to the agency for administering or enforcing the rules because exempting or setting lesser

standards of compliance for a small business is not in the best interest of the public.

26. Identify the impact on the public interest of exempting or setting lesser standards of compliance for small

businesses.

The proposed rules have no impact on a small business, so no exemption was considered.

27. Describe whether and how the agency has involved small businesses in the development of the proposed rules.

No small business were involved in the development of the proposed rules.

A. If small businesses were involved in the development of the rules, please identify the business(es).

No small business were involved in the development of the proposed rules.

Cost-Benefit Analysis of Rules (independent of statutory impact)

28. Estimate the actual statewide compliance costs of the rule amendments on businesses or groups.

There are no estimated compliance costs with these rule amendments on businesses or groups.

A. Identify the businesses or groups who will be directly affected by, bear the cost of, or directly benefit from the

proposed rules.

No businesses or groups will be directly affected or benefitted by the proposed rules. No additional costs will be

imposed on any businesses or groups.

MCL 24.245(3)

RIS-Page 9

B. What additional costs will be imposed on businesses and other groups as a result of these proposed rules (i.e.

new equipment, supplies, labor, accounting, or recordkeeping)? Please identify the types and number of businesses

and groups. Be sure to quantify how each entity will be affected.

The estimated cost to complete implicit bias training will vary, depending on the program chosen by the health care

professional. Several Michigan hospitals offer implicit bias training free of charge.

29. Estimate the actual statewide compliance costs of the proposed rules on individuals (regulated individuals or

the public). Include the costs of education, training, application fees, examination fees, license fees, new

equipment, supplies, labor, accounting, or recordkeeping.

A cost is associated with the renewal of a license or registration, but the proposed rules do not address that cost. The

proposed rules only establish license and registration renewal dates. The estimated cost to take implicit bias training

will vary, depending on the program chosen. Several Michigan hospitals offer training free of charge.

A. How many and what category of individuals will be affected by the rules?

All licensees, registrants, and applicants who are regulated under Article 15 of the Public Health Code are affected by

the proposed rules.

B. What qualitative and quantitative impact do the proposed changes in rules have on these individuals?

The estimated cost to take implicit bias training will vary, depending on the program chosen. Several Michigan

hospitals offer this training free of charge.

30. Quantify any cost reductions to businesses, individuals, groups of individuals, or governmental units as a result

of the proposed rules.

There are no cost reductions to businesses, individuals, groups of individuals, or governmental units as a result of the

proposed rules.

31. Estimate the primary and direct benefits and any secondary or indirect benefits of the proposed rules. Please

provide both quantitative and qualitative information, as well as your assumptions.

The benefits of the proposed rules include: 1) Ensuring that licensees and registrants will be aware of renewal

timelines; 2) Ensuring that applicants for relicensure and reregistration will become aware of how implicit biases

result in barriers and disparities in access to and the provision of health care services; and 3) Ensuring that the health

care professional will be empowered to take appropriate actions to remedy those inequities.

32. Explain how the proposed rules will impact business growth and job creation (or elimination) in Michigan.

The rules are not expected to have an impact on business growth, job creation, or job elimination in Michigan.

33. Identify any individuals or businesses who will be disproportionately affected by the rules as a result of their

industrial sector, segment of the public, business size, or geographic location.

The department does not expect any individuals or businesses to be disproportionately impacted by the rules as a

result of their industrial sector, segment of the public, business size, or geographic location.

34. Identify the sources the agency relied upon in compiling the regulatory impact statement, including the

methodology utilized in determining the existence and extent of the impact of the proposed rules and a cost-

benefit analysis of the proposed rules.

MCL 24.245(3)

RIS-Page 10

Illinois: http://ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1319&ChapAct=225%26nbsp%3BILCS%26nbsp%3B90%

2F&ChapterID=24&ChapterName=PROFESSIONS+AND+OCCUPATIONS&ActName=Illinois+Physical+Therapy

+Act%2E; http://ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1319&ChapAct=225%26nbsp%3BILCS%26nbsp%

3B90%

2F&ChapterID=24&ChapterName=PROFESSIONS+AND+OCCUPATIONS&ActName=Illinois+Physical+Therapy

+Act%2E; https://www.ilga.gov/legislation/101/HB/10100HB5488.htm; https://trackbill.com/bill/illinois-senate-bill-

132-medical-implicit-bias-training/1658669/; https://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=101-

0390

Indiana: http://iga.in.gov/legislative/2020/bills/house/1250#document-026c392e

Kentucky: https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=44609

Minnesota: https://www.revisor.mn.gov/rules/6305.0400/?keyword_type=all&keyword=nurse+english;

https://www.health.state.mn.us/communities/practice/resources/equitylibrary/facebook-bias.html

New York: http://www.op.nysed.gov/english.htm;

https://www.nysenate.gov/legislation/bills/2019/s6797#:~:text=BILL%20NUMBER%3A%20S6797%

20SPONSOR%3A%20SANDERS%20TITLE%20OF%20BILL%3A,order%20to%20maintain%20their%

20license%20in%20good%20standing.

Ohio: http://codes.ohio.gov/oac/4723-7-04v1; https://www.ohioafp.org/education/limiting-implicit-bias-training/

Pennsylvania: https://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?

txtType=HTM&sessYr=2019&sessInd=0&billBody=H&billTyp=B&billNbr=2110&pn=2995

Wisconsin: http://docs.legis.wisconsin.gov/code/admin_code/pt/2/01/8/c

A. How were estimates made, and what were your assumptions? Include internal and external sources, published

reports, information provided by associations or organizations, etc., that demonstrate a need for the proposed

rules.

Since the rules are required by statute and Executive Directive, no estimates were made.

Alternative to Regulation

35. Identify any reasonable alternatives to the proposed rules that would achieve the same or similar goals.

Since the rules are required by statute and Executive Directive, there are no reasonable alternatives to the proposed

rules.

A. Please include any statutory amendments that may be necessary to achieve such alternatives.

Since the rules are required by statute, a statutory change would be needed to provide an alternative.

36. Discuss the feasibility of establishing a regulatory program similar to that proposed in the rules that would

operate through private market-based mechanisms. Please include a discussion of private market-based systems

utilized by other states.

It is not feasible to establish a regulatory program similar to the proposed rules because state statute requires that the

department establish the date pertaining to the renewal of licenses and registrations regulated by the Public Health

Code, MCL 333.16194(1).

Private market-based mechanisms do not provide for equity in access to or the provision of health care services.

37. Discuss all significant alternatives the agency considered during rule development and why they were not

incorporated into the rules. This section should include ideas considered both during internal discussions and

discussions with stakeholders, affected parties, or advisory groups.

MCL 24.245(3)

RIS-Page 11

Since the rules are specifically required by statute or Executive Directive, there are no alternatives to the proposed

rules that the agency could consider. They are necessary for the administration and enforcement of the licensing

process.

Additional Information

38. As required by MCL 24.245b(1)(c), please describe any instructions regarding the method of complying with

the rules, if applicable.

The instructions for compliance are included in the rules.

MCL 24.245(3)